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Injury Analysis: Stay on Your Toes

Jeff Stotts

Jeff Stotts works as a Certified Athletic Trainer (MAT, ATC, PES, CES). He won the 2011 Best Fantasy Football Article in Print from the Fantasy Sports Trade Association.

Toe injuries aren't the first injury fantasy owners usually mention when discussing their most-feared ailments. However, the importance of these 10 little digits cannot be overstated, and problems in the area can present all kinds of issues for players.

Two prominent fantasy players, Jets wide receiver Brandon Marshall and Bills running back LeSean McCoy, are dealing with toe-related injuries as training camps approach. But before we discuss what their injuries mean to fantasy owners, first some background on the importance of toes and why toe injuries can be so devastating.

Toes play an elaborate role in weight-bearing and balance and are one of the primary areas of the foot responsible for fluid and efficient walking and running. For a player running the field, the toes aid in acceleration and help make each stride fluid by extending the lever arm of the foot. The intrinsic muscles of the toes are active throughout the weight-bearing phase. The big toe in particular is a key component in weight-bearing assuming forces as great as 70 to 100 percent of the body's weight.

An injury to the area, whether it is a strain or sprain, can be extremely limiting as the individual's fluidity during gait is thrown out of whack. While a toe injury may not end a season like a torn ACL, it can prove to be even more maddening as the player remains active but hampered and unable to effectively produce.

The toe injury most commonly associated with football is turf toe, an injury that happens when the big toe is forced into hyperextension, spraining a joint known as the metatarsophalangeal (MTP) joint. A turf toe injury can occur in varying degrees with the mildest of injuries involving just the ligament and the associated capsule. However, in some extreme cases tiny bones at the base of the big toe can break or the tendon that houses these bones can be strained. Worse, turf toe can take considerable time to heal and is often easily aggravated.

A non-operative approach is usually taken first as the injured player is treated with anti-inflammatory medication and modalities like ice. Cleats can be modified to protect against turf toe and tape jobs to support the toe are possible. However, running backs and wide receivers don't always respond to shoe alterations very well. Rest remains the best course of action, something most players and teams want to avoid. As a result the affected player often attempts to play with the injury, elevating his inherent injury risk and decreasing his overall productivity.

Receiver and defensive back are the two positions most often affected by toe injuries like turf toe. Hall of Fame cornerback Deion Sanders was hampered late in his career by turf toe and underwent three surgeries on the affected digit. Wide receiver Santonio Holmes' first season with the Jets ended with a nagging turf toe injury that limited his performance in the postseason. Wide receiver Terrell Owens suffered a sprained toe during mini-camp with Buffalo, which carried over into the regular season. Just last season, Cincinnati wideout A.J. Green missed three consecutive games after aggravating a toe injury sustained earlier in the year.

Toe injuries have also been known to sideline running backs and quarterbacks. Darren McFadden's best year as a professional prematurely ended due to turf toe as he missed the 2010 season finale. Former Cardinals running back Beanie Wells missed half of the 2012 season with a severe case of turf toe while a jammed big toe in 2008 limited former MVP LaDainian Tomlinson to what was then a career low in rushing. Finally, the only two games Atlanta quarterback Matt Ryan has missed during his professional career were the result of a turf toe-related injury.

Given the established precedent and the circumstances discussed, the news that Brandon Marshall is already limited by a toe-related problem is a major red flag entering this year's drafts. The situation is complicated even further given Marshall's extensive history of leg injuries. Although Marshall is expected to be available for training camp, don't be surprised if he continues to report problems with the area. Marshall's age and New York's quarterback situation also remain factors to be considered.

While the effects of a toe injury have me worried about Marshall, the opposite is true for LeSean McCoy. McCoy had what some considered a down year last season as he failed to live up to preseason hype. However, a lingering turf toe injury sustained in training camp may have been one of the primary culprits as McCoy's mobility appeared limited, especially during the first quarter of the season. Now rested and healthy, Shady seems poised for a bounce-back campaign and could be a steal in the second round.